Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region
Objectives In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries.Design Policy review.Setting 47 countries within the WHO African region.Participants National HTS policies fro...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/12/e071198.full |
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| author | Céline Lastrucci Cheryl Johnson Anita Sands Rachel Baggaley Muhammad S Jamil Magdalena Barr-DiChiara Emmanuel Fajardo Nayé Bah Casimir Manzengo Mingiedi Ndoungou Salla Ba Fausta Mosha Frank John Lule Margaret Alia Samson Paul Lago Hughes |
| author_facet | Céline Lastrucci Cheryl Johnson Anita Sands Rachel Baggaley Muhammad S Jamil Magdalena Barr-DiChiara Emmanuel Fajardo Nayé Bah Casimir Manzengo Mingiedi Ndoungou Salla Ba Fausta Mosha Frank John Lule Margaret Alia Samson Paul Lago Hughes |
| author_sort | Céline Lastrucci |
| collection | DOAJ |
| description | Objectives In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries.Design Policy review.Setting 47 countries within the WHO African region.Participants National HTS policies from the WHO African region as of December 2021.Primary and secondary outcome measures: Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption.Results National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies.Conclusions Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs. |
| format | Article |
| id | doaj-art-64170a1cf1874faab4c8d809fa363d63 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-64170a1cf1874faab4c8d809fa363d632025-08-20T03:48:42ZengBMJ Publishing GroupBMJ Open2044-60552023-12-01131210.1136/bmjopen-2022-071198Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African regionCéline Lastrucci0Cheryl Johnson1Anita Sands2Rachel Baggaley3Muhammad S Jamil4Magdalena Barr-DiChiara5Emmanuel Fajardo6Nayé Bah7Casimir Manzengo Mingiedi8Ndoungou Salla Ba9Fausta Mosha10Frank John Lule11Margaret Alia Samson Paul12Lago Hughes13Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland3 Department of HIV/AIDS, World Health Organization, Geneva, SwitzerlandDepartment of Regulation and Prequalification, World Health Organization, Geneve, GE, Switzerland2 World Health Organization, Geneva, SwitzerlandGlobal HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland4 Department of Global Programmes of HIV, Hepatitis and HIV, World Health Organization, Geneva, SwitzerlandGlobal HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, SwitzerlandWorld Health Organization Regional Office for Africa, Bamako, MaliInter-country support team for Central Africa, World Health Organization Regional Office for Africa, Libreville, GabonInter-country support team for Western and Central Africa, World Health Organization Regional Office for Africa, Ouagadougou, Burkina FasoInter-country support team for Eastern and Southern Africa, World Health Organization Regional Office for Africa, Harare, ZimbabweWorld Health Organization Regional Office for Africa, Brazzaville, CongoWorld Health Organization Regional Office for Africa, Brazzaville, CongoWorld Health Organization Regional Office for Africa, Brazzaville, CongoObjectives In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries.Design Policy review.Setting 47 countries within the WHO African region.Participants National HTS policies from the WHO African region as of December 2021.Primary and secondary outcome measures: Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption.Results National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies.Conclusions Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs.https://bmjopen.bmj.com/content/13/12/e071198.full |
| spellingShingle | Céline Lastrucci Cheryl Johnson Anita Sands Rachel Baggaley Muhammad S Jamil Magdalena Barr-DiChiara Emmanuel Fajardo Nayé Bah Casimir Manzengo Mingiedi Ndoungou Salla Ba Fausta Mosha Frank John Lule Margaret Alia Samson Paul Lago Hughes Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region BMJ Open |
| title | Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region |
| title_full | Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region |
| title_fullStr | Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region |
| title_full_unstemmed | Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region |
| title_short | Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region |
| title_sort | country adoption of who 2019 guidance on hiv testing strategies and algorithms a policy review across the who african region |
| url | https://bmjopen.bmj.com/content/13/12/e071198.full |
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